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Developing Nutrition Curriculum in a Family Medicine Residency
Introductions
Tufts Family Medicine Residency Boston area 24 residents 8 full time faculty
Road Map
Define our problems What are the national
recommendations Discuss our solutions Small group discussions
Defining the problem?
Identifying the lack of nutrition education in the residency setting
Identifying the lack of precepting by faculty on nutrition
Identifying the lack of communication with dietitians on our staff
What are the Guidelines?
American Academy of Family Physicians
Association of Departments of Family Medicine
Association of Family Practice Residency Directors
Society of Teachers of Family Medicine.
What are the Guidelines?Attitude
Nutrition is an integral part of: Health promotion and disease prevention-
Mortality and morbidity could be significantly reduced through primary prevention targeting dietary risk factors throughout the life cycle.
Medical treatment of disease-nutritional status has a large impact on the ability to respond to medical interventions.
Diagnosis and role-appropriate management of:
What are the Guidelines?Attitude
Dietary intake is influenced by a variety of patient factors, including: Culture Socioeconomic Psychosocial and mental health Knowledge General health and lifestyle
What are the Guidelines?Attitude
Nutrition consultants should be utilized when appropriate to help provide counseling for at-risk patients.
What are the Guidelines? Knowledge
General principles of nutrition Nutritional assessment Nutritional issues of different stages of
the life cycle The role of nutrition in the prevention
and treatment of specific diseases Weight loss strategies and counseling
What are the Guidelines? Knowledge
Disordered eating Use of dietary supplements Preventing and recognizing and
treating foodborne illness Allergies and food intolerance Physical activity and sports Community Resources
What are the Guidelines? Skills Integrating nutrition assessment and
intervention into the medical history, review of systems, physical examination, laboratory evaluation and plan of care.
Assessing the nutritional status and writing diet prescriptions for inpatients
laboratory and metabolic studies related to nutritional assessment.
What are the Guidelines? Skills Counseling patients and family members
about specific nutritional needs related to stages of the life cycle, lifestyle and habits, disease prevention and/or disease.
Counseling patients on safe lifestyle approaches to weight management and balancing caloric intake and physical activity.
Advising on vitamin, mineral and other dietary and botanic supplements.
Collaborating with registered dieticians and certified diabetes educators
BottomlineBasically good family
medicine
Nutrition Challenges in Practice
Can’t know or do it all, so need to know how to refer
Not strong reimbursement from Insurance
Understand that much of patient’s nutrition occurs outside your office
Challenges Particular to Family Medicine in teaching nutrition
Get buy in from residents that this is important
Many have no training in medical school
Culture of the residency
Challenges Particular to Family Medicine Teaching Nutrition
Faculty Training Need buy-in of
higher-ups Need buy-in of
patients Where do you
teach it in the curriculum
What we did at Tufts…
Started a Nutrition education taskforce Got buy in from faculty Got buy in from residency director Got buy in from residents
Nutrition Curriculum Taskforce
Dr. Margo Woods (Tufts school for nutrition)
Erika Damon (nutritionist on staff) 2 faculty 1 resident
Nutrition curriculum goals
Goal 1 – increase the precepting of nutritional interventions by our faculty
Goal 2 – integrate more didactics and case based learning for the residents
Goal 3 – Use standardized patients with the residents and faculty
What is the dash diet
DASH Diet
Creation of the curriculm
Based on the Dash diet 3 messages Focus on 4 chronic conditions Develop scripts Develop patient information sheets Posters for patient education
What is problem
Hypertension Obesity Diabetes High Cholesterol
Phase 1 Faculty Development
Faculty in-services Precepting skills How DASH applies to 4 conditions Piloting with own patients scripts Piloting with their own patients the
patient information sheets
Faculty Development
I think we did 4 inservces Donuts to yogurt
Phase 2 Case Based Lectures Jade please list the lectures that
occurred in the curriculum ???8 one-hour lectures to residents over
4 months Topics
Personal nutrition assessment, usual intake, behavioral skills
DM, hypertension, obesity, CVD Included case discussion, diet analysis
and recommendations based on the DASH diet
Case Based Lectures
Cardiovascular disease Jade what did you do for your
lectures- should we give specifics for each talk or just the general outline? Or more detail on one and then general?
Case Based Lectures
Diabetes Mellitus Jade what did you do for your
lectures- should we give specifics for each talk or just the general outline? Or more detail on one and then general?
Case Based Lectures
Obesity Jade what did you do for your
lectures- should we give specifics for each talk or just the general outline? Or more detail on one and then general?
Case Based Lectures
Hypertension Case example Dietary history with usual intake Analysis Practical dietary revision ideas
Fit-day.com
Residents asked to keep their own record for one week.
Goals:
Benefits seen:
Standardized Patients
Faculty Students
Physcial Exam Form changes SOCIAL -
Occupation/Lives with – Tobacco Y N ? QuitETOH – Y N CAGE Pos Neg Drugs /FirearmsDV screen (safe?)Nutrition: ? Weight concerns Servings Fruits/veg ___ Soda____ Fiber_____Exercise / x weekUV protection/ seatbelts
Nursing Inservices
BMI
Preceptors Chart Review
Changed routine chart review
How did we evaluate residents
Knowledge Questionnaire Attitude Questionnaire Behavior Questionnaire
Attitude Survey
McGaghie, W. et al 45 items survey with 5 subscales
Behavior Survey
We developed our own Jade Cut and paste a few example
of some sentences
Knowledge Survey
Jade cut and past Jade Cut and paste a few example
of some sentences
How did we evaluate faculty
Knowledge Questionnaire Attitude Questionnaire Different questionnaires
Behavior Questionnaire
Obstacles
Solutions
Results residents
Knowledge Questionnaire Attitude Questionnaire Behavior Questionnaire
Results faculty
Jade How many predicated Any trends in their personal
questionnaires ETC
Jade can you put down unique faculty facts like how many precept,
how many had knowledge of nutrition
How did they get that knowledge etv
Our future directions Integrating Nutrition as a Basic Skill Chart review Faculty development
Transition to small groups
Create Your Own Curriculum
Challenges in your setting?
Think Outside the Box
What are your needs? Who has skills your
residents need or need to know about?
Who would be a good “dance partner”?
IDEAS
Resources
There are lots of them out there
STFM Group on nutrition
Guidelines and curriculum Web base training Model Curriculum Supporting literature
STFM Nutrition Education Integrating nutrition education within other STFM groups
and maintaining resources for family medicine educators to use in enhancing nutrition education.
STFM Physician's Curriculum on Clinical Nutrition
The group maintains a password protected web site with new strategies for teaching nutrition in clerkships and residencies. Contact [email protected] for a free ID and password.
Listserve: contact [email protected] or [email protected].
http://www.nhlbi.nih.gov/funding/training/naa/
http://www.nhlbi.nih.gov/funding/training/naa/
Nutrition Curriculum Guide For Training Physicians
Nutrition Resources Physician's curriculum in clinical nutrition- A
competency based approach for primary care, Kansas City, MO: Group on Nutrition Education, Society of Teachers of Family Medicine, 1995.
Manual of Clinical Dietetics, 5th edition. Chicago, IL: The American Dietetic Association, 1996.
Mahan LK and Escott-Stump S. Krause's Food, nutrition and diet therapy, 10th ed. Harcourt, Brace and Co. 1999.
Modern Nutrition in Health and Disease, 9th Edition, Williams and Wickins, 1999.
Medical Nutrition and Disease, Blackwell Science Inc., 1996
